Exam 3: NSG123/ NSG 123 (Latest 2024/ 2025 Update) Med Surg 1| Questions and Verified Answers| 100% Correct| Grade A- Herzing
Exam 3: NSG123/ NSG 123 (Latest 2024/
2025 Update) Med Surg 1| Questions and
Verified Answers| 100% Correct| Grade AHerzing
Q: What is the reflux (backward flow) of urine from the urethra into the bladder?
Answer:
Ureterovesical reflux
Q: Preferred measure to establish bacteriuria
Answer:
Clean catch midstream urine specimen, urine culture
Q: Types of Lower UTI
Answer:
Bacterial cystitis (inflammation of the urinary bladder), bacterial prostatitis (inflammation of the
prostate gland), and bacterial urethritis (inflammation of the urethra).
Q: Types of Upper UTI
Answer:
Much less common and include acute or chronic pyelonephritis (inflammation of the renal
pelvis), interstitial nephritis (inflammation of the kidney), and kidney abscesses
Q: What should patients use to record voiding frequency and urine volume?
Answer:
Voiding Diary
Q: What are the names of Alpha Blockers used to treat BPH
Answer:
Alfuzosin, Tamsulosin, Silodosin, Doxazosin, Terazosin
Q: What are the names of 5-ARI medications used to treat BPH
Answer:
Finasteride and Dutasteride
Q: What percentage of men over 60 year of age have BPH?
Answer:
50%
Q: What percentage of men over 85 years of age have BPH?
Answer:
90%
Q: What PDE-5 inhibitors are currently available for use in ED?
Answer:
Currently available PDE-5 inhibitors include sildenafil (Viagra), vardenafil (Levitra), and
tadalafil (Cialis)
Q: 5 Types of Treatment for ED
Answer:
Oral Medications
Penile Injections
Urethral suppository
Penile implants
Negative pressure vacuum device
Q: Psychogenic Causes of ED
Answer:
Anxiety, fatigue, depression, pressure to perform sexually, negative body image, and absence of
desire/privacy/trust
Q: Organic Causes of ED
Answer:
Cardiovascular Disease
Endocrine Disease
Cirrhosis
Chronic Kidney Injury
GU Conditions
Hematologic Conditions
Neurological Disorders
Alcohol/Smoking
Medications
Q: How often do we check BP to see if the hypertension is not stress related?
Answer:
2 times
Q: How can a nurse evaluate the effectiveness of blood pressure medication such as Thiazide
and CCB?
Answer:
Check patients BP
Q: How does angiotensin converting enzyme decrease BP?
Answer:
Decreasing sodium and water retention
Q: T/F
Symptom of left ventricular failure is crackles in the lungs
Answer:
True
Q: T/F
Iron deficiency anemia is caused by bone marrow not producing RBC adequately
Answer:
True, not enough iron to make RBC
Q: What assessment finding would a nurse expect to show effective iron deficiency anemia
treatment?
Answer:
Client reports an increase in tolerating daily living activities
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“Why is hypertension called the “”Silent Killer””?” Hypertension is sometimes called the silent killer because people who have it are often symptom free
Pre-hypertension The category of prehypertension is used to emphasize that people whose blood pressure begins to rise above 120/80 mm Hg are at risk to become hypertensive
Stage One Hypertension Stage 1: Systolic of 140-159 or Diastolic 90-99
Stage Two Hypertension Stage2: Systolic over 160 or Diastolic over 100
Primary Hypertension Definition About 95% of patients with high blood pressure have primary hypertension (also called essential hypertension), which is defined as high blood pressure from an unidentified cause
Secondary Hypertension Definition about 5%, have secondary hypertension, which occurs when a cause for the high blood pressure can be identified. These causes include chronic kidney disease, renal artery stenosis, hyperaldosteronism (mineralocorticoid hypertension), pheochromocytoma, and sleep apnea
Benign Prostatic Hyperplasia: Benign prostatic hyperplasia (BPH) is a noncancerous enlargement or hypertrophy of the prostate, and one of the most common diseases in aging men.
Signs/Symptoms of BPH Obstructive and irritative symptoms may include urinary frequency, urgency, nocturia, hesitancy in starting urination, decreased and intermittent force of stream and the sensation of incomplete bladder emptying, abdominal straining with urination, a decrease in the volume and force of the urinary stream, dribbling (urine dribbles out after urination), and complications of acute urinary retention and recurrent UTIs. Normally, residual urine amounts to no more than 50 mL in the middle-aged adult and less than 50 to 100 mL in the older adult
What is the reflux (backward flow) of urine from the urethra into the bladder? Ureterovesical reflux
Preferred measure to establish bacteriuria Clean catch midstream urine specimen, urine culture
Types of Lower UTI Bacterial cystitis (inflammation of the urinary bladder), bacterial prostatitis (inflammation of the prostate gland), and bacterial urethritis (inflammation of the urethra).
Types of Upper UTI Much less common and include acute or chronic pyelonephritis (inflammation of the renal pelvis), interstitial nephritis (inflammation of the kidney), and kidney abscesses
What should patients use to record voiding frequency and urine volume? Voiding Diary
What are the names of Alpha Blockers used to treat BPH Alfuzosin, Tamsulosin, Silodosin, Doxazosin, Terazosin
What are the names of 5-ARI medications used to treat BPH Finasteride and Dutasteride
What percentage of men over 60 year of age have BPH? 50%
What percentage of men over 85 years of age have BPH? 90%
What PDE-5 inhibitors are currently available for use in ED? Currently available PDE-5 inhibitors include sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis)
5 Types of Treatment for ED Oral MedicationsPenile InjectionsUrethral suppositoryPenile implantsNegative pressure vacuum device
Psychogenic Causes of ED Anxiety, fatigue, depression, pressure to perform sexually, negative body image, and absence of desire/privacy/trust
Organic Causes of ED Cardiovascular Disease Endocrine Disease Cirrhosis Chronic Kidney Injury GU Conditions Hematologic ConditionsNeurological Disorders Alcohol/SmokingMedications
How often do we check BP to see if the hypertension is not stress related? 2 times
How can a nurse evaluate the effectiveness of blood pressure medication such as Thiazide and CCB? Check patients BP
How does angiotensin converting enzyme decrease BP? Decreasing sodium and water retention
T/FSymptom of left ventricular failure is crackles in the lungs True
T/FIron deficiency anemia is caused by bone marrow not producing RBC adequately True, not enough iron to make RBC
What assessment finding would a nurse expect to show effective iron deficiency anemia treatment? Client reports an increase in tolerating daily living activities
Is this patient high risk for developing iron deficiency anemia? Client with history of menorrhagia and is on strict vegetarian diet Yes, menorrhagia and vegetarian
Is this patient at risk for pernicious anemia?50-year-old with gastric bypass surgery one year ago Yes, gastric bypass
Key symptom in hemolytic transfusion reaction Back pain
What assessment finding would the nurse expect on a client whose platelet level is 18,000/mm3 Petechiae
2 Main cuases of Immune Thrombocytopenic Purpura HIV & Hepatitis
5 Ways bacteria may enter urinary tract Sexual intercourseCatheterTransurethral routeBlood streamFistula to intestine
5 Parts of assessment for patient with urinary incontinence I&OMedicationsVoiding historyHealth historyResidual urine test (PVR post void residual test)
What is the urine remaining in the bladder after voiding? Residual Urine
Drug Class of Choice for Urinary Incontinence Anticholinergic (Ditropan XL, Gelnique, Oxytrol) they have antispasmodic effects on smooth muscleOxybutynin (Oxytrol)
80% of kidney stones have this as the base substance Calcium
4 Things to do for Medical Management of Kidney Stones Treat the pain (opioid)IV FluidsDietStrain urine to catch the stone to see if they passed the stone (surgery if too big)
Blood Chemistries to Review for Urinary Stones CreatineCalciumUric AcidSodiumpH
What are two causes of kidney stones? Hypercalcemia (high serum calcium)Hypercalciuria (high calcium urine)
Risk Factors for Kidney Stones (hypercalcemia & hypercalciuria) DehydrationMedications (antacids, laxatives)GeneticsHyperparathyroidismCancerExcessive intake of vitamin DExcessive intake of milk and alkaliPolycythemia vera
Lifestyle Modifications for Hypertension Decrease sodiumDecrease alcoholCut down on caffeineIncrease fruits and veggies
Hypertensive Emergency A hypertensive emergency is a situation in which blood pressures are extremely elevated and must be lowered quickly (not necessarily to less than 140/90 mm Hg) to halt or prevent damage to the target organs. Hypertensive emergencies are acute, life-threatening blood pressure elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur.
Hypertensive Urgency Hypertensive urgency describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage.
Hypertensive Urgancy Associated Symptoms and Goal for Normalizing BP Hypertensive urgency describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage. Elevated blood pressures associated with severe headaches, nosebleeds, or anxiety are classified as urgencies. In these situations, oral agents can be given with the goal of normalizing blood pressure within 24 to 48 hours.
Choice Medications for Hypertensive Urgency Oral doses of fast-acting agents such as beta-adrenergic blockers (i.e., labetalol [Trandate]), ACE inhibitors (i.e., captopril [Capoten]), or alpha2-agonists (i.e., clonidine [Catapres]) are recommended for the treatment of hypertensive urgencies.
First Line Therapy for Hypertension Current guidelines suggest that thiazide diuretics (e.g., chlorthalidone, hydrochlorothiazide) be used as first-line therapy, either alone (monotherapy) or with an ACE inhibitor, ARB, or CCB
Congestion Symptoms Associated with HF Dyspnea, Orthopnea, Paroxysmal nocturnal dyspnea (dyspnea attack at night), Cough (recumbent or exertional), Pulmonary crackles that do not clear with cough, Weight gain (rapid), Dependent edema, Abdominal bloating or discomfort, Ascites, Jugular venous distention, Sleep disturbance (anxiety or air hunger), Fatigue
Perfusion Symptoms Associated with HF Decreased exercise tolerance, Muscle wasting or weakness, Anorexia, Nausea, Unexplained weight loss, Ligh headedness, Dizziness, Unexplained confusion, Altered mental status, Resting tachycardia, Daytime oliguria with recumbent nocturia, Cool or Vasoconstricted extremities, Pallor, Cyanosis
Right Sided HF Increased venous pressure leads to jugular venous distention (JVD) and increased capillary hydrostatic pressure throughout the venous system. Systemic clinical manifestations include edema of the lower extremities (dependent edema), hepatomegaly (enlargement of the liver), ascites (accumulation of fluid in the peritoneal cavity), and weight gain due to retention of fluid. Edema usually affects the feet and ankles and worsens when the patient stands or sits for a long period.
Left Sided HF “The clinical manifestations of pulmonary congestion include dyspnea, cough, pulmonary crackles, and low oxygen saturation levels. An extra heart sound, the S3, or “”ventricular gallop,”” may be detected on auscultation. It is caused by abnormal ventricular filling. Dyspnea with minimal activitia, orthopnea (prop up with pillows). The cough associated with left ventricular failure is initially dry and nonproductive. Most often, patients complain of a dry hacking cough that may be mislabeled as asthma or chronic obstructive pulmonary disease (COPD)”
Diagnosis Confirmation of HF and Other Tests Performed An echocardiogram is usually performed to determine the EF, identify anatomic features such as structural abnormalities and valve malfunction, and confirm the diagnosis of HF. A chest x-ray and a 12-lead electrocardiogram (ECG) are obtained to assist in the diagnosis. Laboratory studies usually performed during the initial workup include serum electrolytes, blood urea nitrogen (BUN), creatinine, liver function tests, thyroid-stimulating hormone, complete blood count (CBC), BNP, and routine urinalysis. The BNP level is a key diagnostic indicator of HF; high levels are a sign of high cardiac filling pressure and can aid in both the diagnosis and management of HF
What lab value helps determine how bad CFH is? BNP
When assessing a patient for JVD what angle should their head be at? 45 degrees
3 Key Signs of Fluid Overload JVDEdemaCrackles
3 Signs/Symptoms Associated with high BP Silent Killer, May have no symptoms Nagging HeadacheNose BleedBlurry Vision
4 Things to Keep in Mind for Proper BP Reading Correct Cuff SizeNo Caffeine right beforeNo painNo legs crossed
Foods to Avoid with Oxalate: (kidney stones) Patients with kidney stones are to avoid intake of oxalate-containing foods (e.g., spinach, strawberries, rhubarb, tea, peanuts, wheat bran).
Foods to Avoid with Uric Acid Stones: (kidney stones) For uric acid stones, the patient is placed on a low-purine diet to reduce the excretion of uric acid in the urine. Foods high in purine (shellfish, anchovies, asparagus, mushrooms, and organ meats) are avoided
Nutritional Teachings for Patient with History of Kidney Stones Avoid protein intake to decrease urinary excretion of calcium and uric acid.Limit sodium intake to 3-4 g/day. Table salt and high-sodium foods should be reduced, because sodium competes with calcium for reabsorption in the kidneys.Be aware that low-calcium diets are not generally recommended, except for true absorptive hypercalciuria. Evidence shows that limiting calcium, especially in women, can lead to osteoporosis and does not prevent stones.Avoid intake of oxalate-containing foods (e.g., spinach, strawberries, rhubarb, tea, peanuts, wheat bran).Drink fluids (ideally water and one glass of cranberry juice per day) every 1-2 hours during the day.Drink two glasses of water at bedtime and an additional glass at each nighttime awakening to prevent urine from becoming too concentrated during the night.
Pyelonephritis Upper UTI Pyelonephritis is a bacterial infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys. Causes involve either the upward spread of bacteria from the bladder or spread from systemic sources reaching the kidney via the bloodstream
Signs/Symptoms Pyelonephritis The patient with acute pyelonephritis has chills, fever, leukocytosis, bacteriuria, and pyuria. Low back pain, flank pain, nausea and vomiting, headache, malaise, and painful urination are common findings. Physical examination reveals pain and tenderness in the area of the costovertebral angle. In addition, symptoms of lower urinary tract involvement, such as urgency and frequency, are common
What medication is used to decrease urinary incontinence symptoms? How does it help? Oxybutynin, acts directly to relax the smooth muscle and inhibits the effects of acetylcholine at muscarinic receptors. Oxybutynin is administered for the relief of bladder instability associated with voiding in patients with uninhibited neurogenic and reflex neurogenic bladder. The extended-release tablets decrease the symptoms of overactive bladder, incontinence, urgency, and frequency.
Adverse Effects of Oxybutynin The most commonly reported CNS adverse effects include drowsiness, dizziness, and blurred vision. Other adverse effects are dry mouth, nausea, urinary hesitancy, and decreased sweating.
Urge Incontinence Definition Urge incontinence is the involuntary loss of urine associated with a strong urge to void that cannot be suppressed. The patient is aware of the need to void but is unable to reach a toilet in time. An uninhibited detrusor contraction is the precipitating factor. This can occur in a patient with neurologic dysfunction that impairs inhibition of bladder contraction or in a patient without overt neurologic dysfunction.
Client Education for Incontinence Regular Voiding Kegal exercises to increase muscle tone
Systolic HF The most common type is an alteration in ventricular contraction called systolic heart failure, which is characterized by a weakened heart muscle.
Diastolic HF Diastolic heart failure, which is characterized by a stiff and noncompliant heart muscle, making it difficult for the ventricle to fill.
DASH Diet Food and Servings 7 or 8 servings of Grains per day4 or 5 servings of vegetables per day4 or 5 servings of fruit per day2 or 3 servings of low fat or fat free dairy foods per dayLess than 2 servings of lean meat, fish, poultry per day4 or 5 servings of nuts, seeds, and dry beans weekly.
How you assess a pt with suspected TOD? What labs are required for screening a patient with suspected TOD? The retinas are examined and laboratory studies are performed to assess possible target organ damage. Routine laboratory tests include urinalysis, blood chemistry (i.e., analysis of sodium, potassium, creatinine, fasting glucose, and total and HDL cholesterol levels), and a 12-lead electrocardiogram. Renal damage may be suggested by elevations in BUN and creatinine levels or by microalbuminuria or macroalbuminuria. Additional studies, such as creatinine clearance, renin level, urine tests, and 24-hour urine protein, may be performed
What does DASH diet stand for? Dietary Approaches to Stop Hypertension
What is the relationship between hypertension and sleep apnea/kidney disease? Sleep apnea & kidney disease can contribute to hypertension
What is Target Organ damage (TOD)? Symptoms A complete history is obtained to assess for other cardiovascular risk factors and for signs and symptoms that indicate target organ damage (i.e., whether specific tissues are damaged by the elevated blood pressure). Manifestations of target organ damage may include angina; shortness of breath; alterations in speech, vision, or balance; nosebleeds; headaches; dizziness; or nocturia
Nursing Management of HF: Goals and Objectives The goals of management of HF are to relieve patient symptoms, to improve functional status and quality of life, and to extend survivalThe objectives of guideline-directed patient management include the following:Improvement of cardiac function with optimal pharmacologic managementReduction of symptoms and improvement of functional statusStabilization of patient condition and lowering of the risk of hospitalizationDelay of the progression of HF and extension of life expectancyPromotion of a lifestyle conducive to cardiac health
4 Key Patient Teachings: HF Low sodium diet (no more than 2g/day)Avoiding excessive fluid intake is usually recommendedStop smokingExercise
Digoxin Uses No longer first line medication. The clinical indications for use of digoxin include the management of mild to moderate heart failure in adults and children. The drug is also used to control the ventricular response rate in adults with chronic atrial fibrillation.
Digoxin Therapeutic Level & When to draw levels Although the therapeutic serum digoxin level is 0.8 to 2.0 ng/mL, the ideal therapeutic range for both men and women in heart failure may be 0.5 to 0.8 ng/mL. Higher serum levels are associated with an increased risk of adverse effects and toxicity without clear evidence of improved efficacy. The serum blood level is drawn prior to the administration of the digoxin dose. The blood sample is drawn at least 6 hours after the previous dose, because distribution of digoxin to the tissues requires about 6 hours.
Clinical Manifestations of Digoxin Toxicity “Clinical manifestations of toxicity: Signs of toxicity include potentially life-threatening heart rhythm disturbances, ranging from slow to rapid ventricular rhythm. Premature ventricular contractions (PVCs) occur commonly with digoxin toxicity and are usually perceived as “”skipped”” heartbeats by patients. Other adverse effects include nausea, vomiting, loss of appetite, abdominal discomfort, vision changes (yellow-green halos and problems with color perception), blurred vision, and mental changes”
Constant Assessments for Digoxin Toxicity The nurse assesses the patient for anorexia, nausea, and vomiting, which are common with digoxin therapy because digoxin stimulates the vomiting center of the brain.
Anemia Definition/Cause Anemia is a condition in which the hemoglobin concentration is lower than normal; it reflects the presence of fewer than the normal number of erythrocytes (i.e., red blood cells [RBCs]) within the circulation
Anemia Clinical Manifestations A person who has become gradually anemic, with hemoglobin levels between 9 and 11 g/dL, usually has fewer or no symptoms other than slight tachycardia on exertion and possibly fatigue
Nursing Management and Treatment of Anemia Management of anemia is directed toward correcting or controlling the cause of the anemia; if the anemia is severe, the erythrocytes that are lost or destroyed may be replaced with a transfusion of packed red blood cells (PRBCs).
Major Goals for Anemia Patients The major goals for the patient may include decreased fatigue, attainment or maintenance of adequate nutrition, maintenance of adequate tissue perfusion, compliance with prescribed therapy, and absence of complications.
Thalassemia: Glucose-6-Phosphate Dehydrogenase Deficiency-Clinical manifestation Patients are asymptomatic and have normal hemoglobin levels and reticulocyte counts most of the time. However, several days after exposure to an offending medication or substance, they may develop pallor, jaundice, and hemoglobinuria (i.e., hemoglobin in the urine). The reticulocyte count increases, and symptoms of hemolysis develop. The diagnosis is made by a screening test for the deficiency or by a quantitative assay of G-6-PD.
Thalassemia: Glucose-6-Phosphate Dehydrogenase Deficiency- Nursing Management Patients are educated about the disease and given a list of medications and substances to avoid. Individuals with G-6-PD deficiency should always seek advice before taking any new medication or supplement. Patients should be instructed to wear Medic-Alert bracelets that identify that they have G-6-PD deficiency. Genetic counseling may be indicated.
Immune Hemolytic Anemias: Type of Thalessemia-Hemolytic anemias can result from exposure of the erythrocyte to antibodies.
Immune Hemolytic Anemias: Clinical Manifestations Clinical manifestations vary and usually reflect the degree of anemia. The hemolysis may range from very mild, in which the patient’s marrow compensates adequately and the patient is asymptomatic, to so severe that the resultant anemia is life-threatening. Most patients complain of fatigue and dizziness. Splenomegaly is the most common physical finding; hepatomegaly, lymphadenopathy, and jaundice are also common.
Pernicious Anemia: Definition and Cause Another cause of Vitamin B12 deficiency is the absence of intrinsic factor; in this particular context, the resultant anemia is called pernicious anemia. Intrinsic factor is normally secreted by cells within the gastric mucosa; it binds with dietary vitamin B12 and travels with it to the ileum, where the vitamin is absorbed. Without intrinsic factor, orally consumed vitamin B12 cannot be adequately absorbed, and erythrocyte production is eventually diminished
Pernicious Anemia Risk Factors: Pernicious anemia tends to run in families; it is primarily a disorder of adults, particularly older adults.
Nursing Management Pernicious Anemia Vitamin B12 deficiency is treated by vitamin B12 replacement. The nurse needs to pay particular attention to ambulation and should assess the patient’s gait and stability, as well as the need for assistive devices (e.g., canes, walkers) and for assistance in managing daily activities
Correct Assessment of JVD JVD is assessed with the patient sitting at a 45° angle; distention greater than 4 cm above the sternal angle is considered abnormal and indicative of right ventricular failure. This is an estimate, not a precise measurement, of high central venous pressure.
Treatment & Evaluation of Goals for Patient with HF Major goals for the patient may include promoting activity and reducing fatigue, relieving fluid overload symptoms, decreasing anxiety or increasing the patient’s ability to manage anxiety, encouraging the patient to verbalize their ability to make decisions and influence outcomes, and educating the patient and family about health management. Nurses play a key role in instructing patients and their families about medication management, a low-sodium diet, moderate alcohol consumption, activity and exercise recommendations, smoking cessation, how to recognize the signs and symptoms of worsening HF, and when to contact the primary provider
Assessment of Iron Deficiency Anemia The definitive method of establishing the diagnosis of iron deficiency anemia is bone marrow aspiration. The aspirate is stained to detect iron, which is at a low level or even absent. However, few patients with suspected iron deficiency anemia undergo bone marrow aspiration. In many patients, the diagnosis can be established with other tests. Typically, patients with iron deficiency anemia have a low serum iron level and an elevated TIBC, which measures the transport protein supplying the marrow with iron as needed
Iron Deficiency Anemia Client Teaching Preventive education is important, because iron deficiency anemia is common in menstruating and pregnant women. Food sources high in iron include organ meats (e.g., beef or calf’s liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron. Iron supplements are usually given in the oral form. Because iron is best absorbed on an empty stomach, the patient is instructed to take the supplement an hour before meals. While taking iron with vitamin C increases absorption of the iron, it also increases the frequency of side effects.
What can cause fluid overload during blood transfusion? If too much blood is infused too quickly, hypervolemia can occur. This condition can be aggravated in patients who alreadyhave increased circulatory volume (e.g., those with heart failure, renal dysfunction, advanced age, acute myocardial infarction)
Signs and Symptoms of Hypervolemia (fluid overload) Signs of circulatory overload include dyspnea, orthopnea, tachycardia, an increase in blood pressure, and sudden anxiety. Jugular vein distention, crackles at the base of the lungs, and hypoxemia will also develop. Pulmonary edema can quickly develop, as manifested by severe dyspnea and coughing of pink, frothy sputum.
S/S of Hemolytic Reaction Symptoms consist of fever, chills, low back pain, nausea, chest tightness, dyspnea, and anxiety.
Platelets Greater than 50,000/mm^3 Bleeding and petechiae usually do not occur
Platelets Less than 20,000/mm^3 petechiae can appear, along with nasal and gingival bleeding, excessive menstrual bleeding, and excessive bleeding after surgery or dental extractions
Platelets less than 5,000/mm^3 spontaneous, potentially fatal central nervous system or GI hemorrhage can occur. If the platelets are dysfunctional as a result of disease (e.g., MDS) or medications (e.g., aspirin), the risk of bleeding may be much greater even when the actual platelet count is not significantly reduced, because the function of the platelets is altered.
Thrombocytopenia Thrombocytopenia (low platelet level) can result from various factors: decreased production of platelets within the bone marrow, increased destruction of platelets, or increased consumption of platelets (e.g., the use of platelets in clot formation).
Patient Education for ITP Patient education addresses signs of exacerbation of disease (e.g., petechiae, ecchymoses), how to contact appropriate health care personnel, the name and type of medication inducing ITP (if appropriate), current medical treatment (medications, side effects, tapering schedule if relevant), and the frequency of monitoring the platelet count. The patient is instructed to avoid all agents that interfere with platelet function, including herbal therapies and OTC medications. The patient should avoid constipation, the Valsalva maneuver (e.g., straining at stool), and vigorous flossing of the teeth. Electric razors should be used for shaving, and soft-bristled toothbrushes should replace stiff-bristled ones.
Causes of Secondary ITP ITP is an autoimmune disorder characterized by a destruction of normal platelets by an unknown stimulus. secondary ITP often results from autoimmune diseases (e.g., antiphospholipid antibody syndrome), viral infections (e.g., hepatitis C, HIV), and various drugs (e.g., sulfa drugs).
Amlodipine: Class & Use Calcium Channel BlockerThey may be especially useful for people with hypertension who also have angina pectoris or other cardiovascular disorders
How does Amlodipine work? Amlodipine inhibits the influx of calcium ions across cardiac and smooth muscle during depolarization, resulting in relaxation and vasodilation. This leads to lowered blood pressure.
Side Effects of Amlodipine Amlodipine is generally well tolerated. Possible adverse effects include headache; drowsiness; fatigue; dizziness; edema of the hands, ankles, and feet; flushing; palpitations; nausea; and abdominal pain.
What are ACE inhibitors used for? Main One to Know: Management of systolic HF Lisinopril
How do ACE Inhibitors work? ACE inhibitors promote vasodilation and diuresis, ultimately decreasing afterload and preload. ACE inhibitors decrease the secretion of aldosterone, a hormone that causes the kidneys to retain sodium and water. ACE inhibitors also promote renal excretion of sodium and fluid
Lab Assessments for Elevated BP Routine laboratory tests include urinalysis, blood chemistry (i.e., analysis of **, potassium, creatinine, fasting glucose, and total and HDL cholesterol levels), and a 12-lead electrocardiogram.
Complications of High BP Potential complications may include the following:Left ventricular hypertrophyMyocardial infarctionHeart failureTIACerebrovascular disease (stroke or brain attack)Renal insufficiency and chronic kidney diseaseRetinal hemorrhage
Assessments Associated with Thiazide Diuretics Prior to administering HCTZ, the nurse assesses the patient for allergy to thiazides and sulfonamides. The nurse also assesses the blood pressure and pulse before administering the medication and periodically following administration. HCTZ is also a potassium-wasting diuretic so a potassium-rich, low-sodium diet is recommended. In addition, potassium supplements may be necessary. Administer with food to avoid GI upset. hroughout therapy, the nurse assesses the patient’s lungs (for adventitious sounds), heart (for an S3), and extremities (for peripheral edema), the patient’s fluid and electrolyte status, and the patient’s weight (daily). Any increase in weight of greater than 2 lb in 24 hours must be reported to the primary health care provider.
For Patients with High BP Check 3 Things Are they actually taking med?Are they exercising?Are they stressed?
Pulmonary Congestion: Definition · Pulmonary congestion occurs when the left ventricle cannot effectively pump blood out of the ventricle into the aorta and the systemic circulation.
Pulmonary Congestion: Clinical Manifestations “The clinical manifestations of pulmonary congestion include dyspnea, cough, pulmonary crackles, and low oxygen saturation levels. An extra heart sound, the S3, or “”ventricular gallop,”” may be detected on auscultation. It is caused by abnormal ventricular filling”
Digoxin Toxicity: S/S A key concern associated with digoxin therapy is digitalis toxicity. Clinical manifestations of toxicity include anorexia, nausea, visual disturbances, confusion, and bradycardia. The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur. A serum digoxin level is obtained if the patient’s renal function changes or there are symptoms of toxicity.
PDE-5 Inhibitors in ED Phosphodiesterase type 5 (PDE-5) inhibitors (oral medications that are used to treat erectile dysfunction) are first-line therapy. During sexual stimulation, PDE-5 inhibitors increase blood flow to the penis.
Directions for Taking PDE-5 Inhibitor When PDE-5 inhibitors are taken about 1 hour before sexual activity, they are effective in producing an erection with sexual stimulation; the erection can last about 1 to 2 hours.
Contraindications of PDE-5 inhibitors These agents are contraindicated in men who take organic nitrates (e.g., isosorbide [Isordil], nitroglycerin), because taken together, these medications can cause side effects such as severe hypotension. In addition, PDE-5 inhibitors must be used with caution in patients with retinopathy, especially in those with diabetic retinopathy.
Catheter Use with BPH If a patient is admitted on an emergency basis because he is unable to void, he is immediately catheterized. The ordinary catheter may be too soft and pliable to advance through the urethra into the bladder. In such cases, a thin wire (stylet) is introduced (by a urologist) into the catheter to prevent the catheter from collapsing when it encounters resistance. A metal catheter with a pronounced prostatic curve may be used if obstruction is severe. A cystostomy (incision into the bladder) may be needed to provide urinary drainage.
Acute Interventions for BPH “The goals of medical management of BPH are to improve quality of life, improve urine flow, relieve obstruction, prevent disease progression, and minimize complications. Treatment depends on the severity of symptoms, the cause of disease, the severity of the obstruction, and the patient’s condition. Patients with mild symptoms and patients with moderate or severe symptoms who are not bothered by them and have not developed complications may be managed with “”watchful waiting.”” With this approach, the patient is monitored and reexamined annually but receives no active intervention”
Clinical Manifestations of PAD The hallmark symptom is intermittent claudication described as aching, cramping, or inducing fatigue or weakness that occurs with some degree of exercise or activity, which is relieved with rest. The pain commonly occurs in muscle groups distal to the area of stenosis or occlusion
Surgical Management of PAD Surgery is reserved for the treatment of severe and disabling claudication or when the limb is at risk for amputation because of tissue necrosis. The choice of the surgical procedure depends on the degree and location of the stenosis or occlusion.
Non Surgical Interventions PAD Radiologic interventional (endovascular) management can include a balloon angioplasty, stent, stent graft, or an atherectomy. These revascularization procedures are less invasive than conventional surgery; their objective is to establish adequate inflow to the distal vessels.If a walking program is combined with weight reduction and cessation of tobacco use, patients often can further improve their activity tolerance.
Medication for Von Willebrand Desmopressin. This medication is available as an injection (DDAVP). It’s a synthetic hormone that controls bleeding by stimulating your body to release more of the von Willebrand factor stored in the lining of your blood vessels. Many doctors consider DDAVP the first treatment for managing von Willebrand disease
Priority Medications to Administer for Renal Colic The immediate objective of treatment of renal or ureteral colic is to relieve the pain until its cause can be eliminated. Opioid analgesic agents are given to prevent shock and syncope that may result from the excruciating pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in treating kidney stone pain because they provide specific pain relief
S/S of Lower UTI Signs and symptoms of an uncomplicated lower UTI include burning on urination, urinary frequency (voiding more than every 3 hours), urgency, nocturia (awakening at night to urinate), incontinence, and suprapubic or pelvic pain. Hematuria and back pain may also be present
Client Education for UTI The patient is encouraged to drink liberal amounts of fluids (water is the best choice) to promote renal blood flow and to flush the bacteria from the urinary tract. Urinary tract irritants (e.g., coffee, tea, citrus, spices, colas, alcohol) should be avoided. Frequent voiding (every 2 to 3 hours) is encouraged to empty the bladder completely, because doing so can lower urine bacterial counts, reduce urinary stasis, and prevent reinfection
Prevention of Upper UTI/Pyelonephritis Early recognition of UTI and prompt treatment are essential to prevent recurrent infection and the possibility of complications, such as kidney disease, sepsis (urosepsis), strictures, and obstructions. The goal of treatment is to prevent infection from progressing and causing permanent kidney damage and injury.
S/S of Ureteral Obstruction Stones lodged in the ureter (ureteral obstruction) cause acute, excruciating, colicky, wavelike pain that radiates down the thigh and to the genitalia. Often, the patient has a desire to void, but little urine is passed, and it usually contains blood because of the abrasive action of the stone. This group of symptoms is called ureteral colic.
Passing of Kidney Stones In general, the patient is able to pass stones 0.5 to 1 cm in diameter. Stones larger than 1 cm in diameter usually must be removed or fragmented (broken up by lithotripsy) so that they can be removed or passed spontaneously. When stones are recovered (whether freely passed by the patient or removed through special procedures), chemical analysis is carried out to determine their composition.
Treatment Regimen of UTI Various treatment regimens have been successful in treating uncomplicated lower UTIs in women: single-dose administration, short-course (3-day) regimens, or 7-day regimens. The trend is toward a shortened course of antibiotic therapy for uncomplicated UTIs, because most cases are cured after 3 days of treatment.
Long Term/Prophylaxis Treatment UTI NitrofurantoinIf infection recurs after completing antimicrobial therapy, another short course (3 to 4 days) of full-dose antimicrobial therapy followed by a regular bedtime dose of an antimicrobial agent may be prescribed. If there is no recurrence, medication is taken every other night for 6 to 7 months. Long-term use of antimicrobial agents decreases the risk of reinfection and may be indicated in patients with recurrent infections.Infections that recur within 2 weeks of therapy do so because organisms of the original offending strain remain. Relapses suggest that the source of bacteriuria may be the upper urinary tract or that initial treatment was inadequate or given for too short a time. Following acute pyelonephritis treatment, the patient may develop a chronic or recurring symptomless infection persisting for months or years. After the initial antibiotic regimen, the patient may need antibiotic therapy for up to 6 weeks if a relapse occurs. A follow-up urine culture is obtained 2 weeks after completion of antibiotic therapy to document clearing of the infection
Nurse Monitoring for TURP Post-Operatively The drainage bag is monitored for bloody urine, and the dressings and surgical incision are examined for bleeding. The color of the urine is carefully noted and documented; a change in color from pink to amber indicates reduced bleeding. Blood pressure, pulse, and respirations are monitored and compared with baseline preoperative vital signs to detect hypotension. The nurse also observes the patient for restlessness, diaphoresis, pallor, any drop in blood pressure, and an increasing pulse rate.
TURP Indicated for BPH. TURP, which is the most common procedure used, can be carried out through endoscopy. The prostate gland is removed in small chips with an electrical cutting loop . This procedure eliminates the risk of transurethral resection syndrome (hyponatremia, hypovolemia).
Post-Operative Assessment for TURP After TURP, the catheter must drain well; an obstructed catheter produces distention of the prostatic capsule and resultant hemorrhage. Furosemide (Lasix) may be prescribed to promote urination and initiate postoperative diuresis, thereby helping to keep the catheter patent. The nurse observes the lower abdomen to ensure that the catheter has not become blocked. A distinct, rounded swelling above the pubis is a manifestation of an overdistended bladder. If the nurse ascertains that the client’s bladder is distended, a portable bladder scanner may be used to determine if urine retention is a problem
Pharmalogical Interventions BPH: 2 Categories Pharmacologic treatment for BPH includes the use of alpha-adrenergic blockers and 5-alpha-reductase inhibitors.
Names & Therapeutic Effect & Side Effects Alpha-Adrenergic Blockers: BPH Alpha-adrenergic blockers, which include alfuzosin (Uroxatral), terazosin (Hytrin), doxazosin (Cardura), and tamsulosin, relax the smooth muscle of the bladder neck and prostate. This improves urine flow and relieves symptoms of BPH. Side effects include dizziness, headache, asthenia/fatigue, postural hypotension, rhinitis, and sexual dysfunction
Names & Therapeutic Effect & Side Effects 5-Alpha-Reductase Inhibitors: BPH The 5-alpha-reductase inhibitors finasteride (Proscar) and dutasteride (Avodart) are used to prevent the conversion of testosterone to DHT and decrease prostate size. Side effects include decreased libido, ejaculatory dysfunction, erectile dysfunction, gynecomastia (breast enlargement), and flushing. Combination therapy (doxazosin and finasteride) has decreased symptoms and reduced clinical progression of BPH
Lifestyle Modifications for Hypertension The nurse can encourage the patient to consult a dietitian to help develop a plan for improving nutrient intake or for weight loss. The program usually consists of restricting sodium and fat intake, increasing intake of fruits and vegetables, and implementing regular physical activity. Explaining that it takes 2 to 3 months for the taste buds to adapt to changes in salt intake may help the patient adjust to reduced salt intake. The patient should be advised to limit alcohol intake, and tobacco should be avoided because anyone with high blood pressure is already at increased risk for heart disease, and smoking amplifies this risk.
Conditions Associated with Hypertesnsive Emergencies Conditions associated with a hypertensive emergency include hypertension of pregnancy, acute myocardial infarction, dissecting aortic aneurysm, and intracranial hemorrhage
Post Surgical Education PAD : The primary objective in the postoperative period is to maintain adequate circulation through the arterial repair. Pulses, Doppler assessment, color and temperature, capillary refill, and sensory and motor function of the affected extremity are checked and compared with those of the other extremity; these values are recorded initially every 15 minutes and then at progressively longer intervals if the patient’s status remains stable. Edema is a normal postoperative finding; however, elevating the extremities and encouraging the patient to exercise the extremities while in bed reduces edema. Graduated compression or anti-embolism stockings may be prescribed for some patients, but care must be taken to avoid compressing distal vessel bypass grafts
Long Term Management PAD The patient is encouraged to make the lifestyle changes necessitated by the onset of a chronic disease, including pain management and modifications in diet, activity, and hygiene (skin care). The nurse ensures that the patient has the knowledge and ability to assess for any postoperative complications such as infection, occlusion of the artery or graft, and decreased blood flow. The nurse assists the patient in developing and implementing a plan to stop using tobacco products.
Types of Drugs used for Hypertension Drugs used in the management of primary hypertension belong to several different groups, including angiotensin-converting enzyme (ACE) inhibitors; angiotensin II receptor blockers (ARBs), also called angiotensin II receptor antagonists; antiadrenergics; calcium channel blockers (CCBs); diuretics; and direct vasodilators. In general, these drugs act to decrease blood pressure by decreasing cardiac output or peripheral vascular resistance.
What to assess before administration of hypertensive drug? Blood Pressure
ACE Inhibitors Hypertension Authorities recommend captopril (Capoten), the prototype ACE inhibitor, and other drugs in this class as first-line agents for treating hypertension. ACE inhibitors reduce proteinuria and slow progression of renal impairment in people with this disease.
CCBs use in Hypertension CCBs may be used for monotherapy or in combination with other drugs. They may be especially useful for people with hypertension who also have angina pectoris or other cardiovascular disorders. Current guidelines recommend that CCBs be used alone or in combination with a thiazide diuretic to treat hypertension. These drugs are recommended as the first-line treatment of hypertension for black patients